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Nursing II Exam 3 > Diabetes > Flashcards

Diabetes Flashcards

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1
Q

Diabetes Mellitus (definition)

A

Disorder of hyperglycemia resulting from defects in insulin secretion, insulin action, or both, leading to abnormalities in carbohydrate, protein, and fat metabolism

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2
Q

Pancreas (function)

A

Produce hormones necessary for the metabolism and cellular utilization of carbs, proteins, and fats

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3
Q

Alpha Cells

A

Produce the hormone glucagon > stimulates the breakdown of glycogen by the liver (increase blood glucose levels)

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4
Q

Glycogenolysis

A

Breakdown of liver glycogen

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5
Q

Gluconeogenesis

A

Formation of glucose from fats and proteins

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6
Q

Beta Cells

A

Secrete insulin; lowers blood glucose when it becomes too high

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7
Q

Delta Cells

A

Produce somatostatin (believed to inhibit both production of glucagon and insulin)

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8
Q

Type 1 DM

A
  • Involves the destruction of beta cells (which produce insulin)
  • Usually occurs at a young age
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9
Q

Type 2 DM

A
  • Insulin resistance

- Occurs later in life due to obesity, inactivity and heredity

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10
Q

Type 1 DM (S/S)

A
  • Hyperglycemia (and development of ketosis)
  • Polyuria
  • Glucosuria
  • Polydipsia
  • Polyphagia (but no weight gain)
  • Weight loss (as the body loses water and breaks down proteins and fats in an attempt to restore energy sources)
  • Malaise, fatigue
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11
Q

Type 2 DM (S/S)

A
  • Hyperglycemia
  • Polyuria
  • Polydipsia
  • Blurred vision
  • Fatigue
  • Paresthesias
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12
Q

Type 2 DM (risk factors)

A
  • History of diabetes in parents or siblings
  • Obesity
  • Physical inactivity
  • Race/ethnicity
  • Women (gestational diabetes, or delivering baby weighing more than 9lbs)
  • HTN
  • High triglyceride levels
  • Metabolic syndrome
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13
Q

Dawn Phenomenon

A
  • Rise in blood glucose between 4am-8am that is not a response to hypoglycemia
  • Occurs in both Type 1 and 2 DM
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14
Q

Somogyi Phenomenon

A

Combo of hypoglycemia during the night with a rebound morning rise to hyperglycemic levels

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15
Q

Diabetic Ketoacidosis (DKA)

A

Develops when there is an absolute deficiency in insulin and an increase in the insulin counterregulatory hormones -> ketogenesis is stimulated

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16
Q

Hyperosmolar Hyperglycemic State (HHS)

A
  • Occurs in Type 2 DM
  • Acute, life-threatening condition characterized by hyperglycemia (greater than 600 mg/dL), hyperosmolarity (340 mOsm/L), and absence of ketosis
  • Can lead to coma or death
17
Q

DKA risk factors

A
  • Lack of sufficient insulin
  • Reduced or missed insulin dose
  • Any condition that increases carbohydrate metabolism (physical or emtional stress, illness, infection, surgery, or trauma)
18
Q

HHS risk factors

A
  • Inadequate fluid intake (dehydration)
  • Decreased kidney function
  • Medical conditions: MI, CVA, sepsis
  • Certain meds: glucocorticoids, diuretics, phenytoin (Dilantin), propranolol (Inderal), and calcium channel blockers
  • Infection or stress
19
Q

Nursing Interventions for DKA/HHS

A
  • Provide rapid isotonic fluid (0.9% sodium chloride) replacement
  • Follow with a hypotonic fluid (0.45% NaCl) to continue replacing losses to total body fluid
  • When glucose levels approach 250 mg/dL, add glucose to the IV fluids to minimize risk of cerebral edema and to prevent hypoglycemia
  • Administer regular insulin 0.1 unit/kg as an IV bolus and then follow with a cont, IV infusion at 0.1 unit/kg/hr
  • Monitor serum potassium levels
  • Give sodium bicarbonate by slow IV for severe acidosis (pH < 7.0)
20
Q

Pt Education for DM Complications

A
  • Wear medical alert bracelet
  • Drink at least 3 L of water/day to prevent dehydration
  • Monitor glucose every 4 hr when ill and continue to take insulin
21
Q

Foot Care

A
  • Inspect feet & wash daily (watch for hot temp)
  • Pat feet dry, esp. between toes and avoid lotion between toes
  • Avoid open-toe shoes/sandals, no barefeet
  • Avoid prolonged sitting, standing, or crossing legs
  • Recommend podiatrist for cutting nails
  • Wear shoes that fit properly
  • Trim toenails straight across and file edges
22
Q

Nutritional Guidelines

A
  • Eat at regular intervals, do NOT skip meals
  • Count grams of carbs consumed
  • Include fiber to increase carb metabolism and to control cholesterol levels
  • Use artificial sweeteners
  • Dietary fats should be low in saturated fat and cholesterol
23
Q

Alcohol for DM pts

A
  • Not encouraged
  • Men should drink no more than 2 drinks, and women no more than 1 drink per day
  • 1.5 oz of alcohol = 2 fat exchanges
  • Drink with meals
24
Q

Acute complication: Hypoglycemia (treatment)

A
  • Give 15 g of rapid-acting sugar (1/2 fruit juice/soda, 2 tsp of sugar or honey), wait 15 mins, check blood glucose
  • If still low, give another 15g of carbohydrate
25
Q

Complications of DM

A
  • HTN, MI, stroke
  • Diabetic retinopathy (impaired vision/blindness)
  • Diabetic neuropathy
  • Diabetic nephropathy

Nursing II Exam 3 (5 decks)

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